Tests Tell When Alzheimer's Patients Should Stop Driving

They include simulations and measures of spatial relationships

MONDAY, Jan. 26, 2004 (HealthDayNews) -- Tests that evaluate spatial relationships between objects and driving simulations are helpful in identifying drivers with Alzheimer's disease who shouldn't be behind the wheel, a new study finds.

Typical "neuropsychological tests" include block design and picture completion tasks. In these tests, patients must match designs or complete pictures using colored blocks.

There is ample evidence that drivers with dementia are at increased risk for car crashes and getting lost while driving, according to the report in the January issue of Neuropsychology.

The researchers reviewed 27 studies on dementia and driving that had been published between 1988 and 2003. Their goal was to find the most effective tests for predicting driving performance.

The best ones were specific skills tests and simulated on-road and non-road tests that evaluated mental status and "visuospatial" skills and predicted driving performance, the study says.

The results of these tests were a more reliable measure of driving ability than observations from family members, the researchers note.

The investigators also found tests that look at attention and concentration were less helpful and not as accurate in predicting driving performance.

These findings have implications for families trying to decide if a relative with early Alzheimer's disease should be driving, says study author Mark Reger, a fellow in psychiatry and behavioral science at the University of Washington School of Medicine.

"Families concerned about whether their loved one is safe to drive might consider neuropsychological testing as a part of driving risk assessment," he says.

Reger notes that "visuospatial problems" are common in people with early Alzheimer's and other dementias, and can cause disorientation or getting lost while driving in familiar environments. They can also lead to car accidents.

However, for many patients in the early stages of Alzheimer's, giving up driving is very difficult, because it means giving up the freedom to go where they want when they want, he says.

"I have sat with Alzheimer's patients who have told me that they will not stop driving," Reger says. "To ask someone who has driven all their life to stop driving is a very serious recommendation that no one should take lightly."

Not every patient is the same, Reger adds. Some patients with mild Alzheimer's should not be driving, while others can continue to drive for a time. "Once the disease has progressed to the moderate or severe stages, it is clear that patients should not be driving," he says.

For families, the decision can be difficult. "In our clinic, we often have families who are concerned whether their loved one is fit to drive, but they are hesitant to say anything or are unsure what to do, and getting some assistance with this kind of testing may be helpful," Reger says.

Some families can be overly concerned. A simple driving mistake may not mean a person is not fit to drive. Other families defer to the patient and do not move quickly to get a dangerous driver off the road, Reger says.

Even if the family doesn't raise the issue, Reger says, their doctor should. Doctors should suggest to patients that they take tests to determine if they are safe drivers.

"This can be in the family's best interest," Reger says. "There can be significant financial and legal implications if patients continue to drive when they shouldn't. Families need to consider the whole scope of risk."

For concerned families, Reger recommends asking their doctor to help patients get checked out with a complete workup that includes both neuropsychological and vision tests, he says.

"This is also something government agencies should be looking into," Reger says. A number of states are looking into better ways of screening drivers at risk, he says.

Stephen McConnell, a senior vice president at the Alzheimer's Association, says this new study provides additional information on mental functioning and driving.

However, what's still needed "is a simple, quick test that can determine a person's driving capability," he says.

Such tests are being developed, but it will take at least five to 10 years before they will be readily available, McConnell notes.

"We recognize that this is a huge social and personal issue. We have to balance public safety and personal independence and rights," he says.

California, McConnell says, requires that doctors report any Alzheimer's diagnosis to the motor vehicle department. Once reported, the patient is usually called in and given a driving test. However, many doctors do not report Alzheimer's cases, McConnell adds.

In addition, 20 other states allow people to report Alzheimer's diagnosis, he notes.

The association does not encourage reporting of an Alzheimer's diagnosis. "We worry that, where there is mandatory reporting, people will be reluctant to get a diagnosis if they think they are going to be reported, " McConnell says.

The association's current position is that "if there is concern that an individual with Alzheimer's disease has impaired driving ability, and the person would like to continue driving, a formal assessment of driving skills should be administered," he says.

McConnell adds that as the population ages, this will become a more pressing problem.

More information

For more on Alzheimer's and driving, check with the National Institute on Aging or the Alzheimer's Association of Los Angeles.

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